Campaign Materials

The Healthy Heart Handbook for Women

Eat for Health

The health of your heart has a lot to do with the foods you eat. The "Dietary Guidelines for Americans" give science-based advice for eating right and being physically active to maintain good health. The guidelines recommend the following healthy eating plans:

"To keep my condition under control I make sure to follow my doctor's advice, take prescriptions, and get treatment when I need it."

— Olga

Although the "Dietary Guidelines for Americans" recommend an excellent basic menu for heart health, you may need to make some additional changes in your diet if you have high blood pressure or high blood cholesterol. You may want to work with a registered dietitian to help you make these changes. A dietitian can teach you about the eating plan that is best for you, determine a reasonable calorie level, and help you choose foods and plan menus. A dietitian can also help you keep track of your progress and encourage you to stay on your eating plan. Talk with your doctor about whether you should get a referral to a registered dietitian. In the meantime, if you have high blood pressure or high blood cholesterol, the following page has some guidelines.

HOW TO READ A NUTRITIONAL FACTS LABEL

Macaroni & Cheese

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StartHere

Nutrition Facts

Serving Size 1 cup (228g)
Serving Per Container 2

CheckCalories

Amount Per Serving

Calories 250

Calories from Fat 110

% Daily Value*

Quick Guide to % Daily Value:

5% or Less Is Low

20% or More Is High

LimittheseNutrients

Total Fat 12g

18%

Saturated Fat 3g

15%

Trans Fat 3g

Cholesterol 30mg

10%

Sodium 470mg

20%

Total Carbohydrate 31g

10%

Dietary Fiber 0g

0%

Sugars 5g

Protein 5g

Get Enoughof theseNutrients

Vitamin A

4%

Vitamin C

2%

Calcium

20%

Iron

4%

Footnote

*

Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending onyour calorie needs:

Calories:

2,000

2,500

Total Fat

Less Than

65g

80g

Sat Fat

Less Than

20g

25g

Cholesterol

Less Than

300mg

300mg

Sodium

Less Than

2,400mg

2,400mg

Total Harbohydrate

300g

375g

Dietary Fiber

25g

30g

Blood Pressure and the DASH Eating Plan
If you have high blood pressure or prehypertension, you may want to follow an eating plan called "DASH." DASH stands for "Dietary Approaches to Stop Hypertension," and the DASH eating plan emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, whole grain products, fish, poultry, beans, seeds, and nuts. The DASH eating plan also contains less salt/sodium, sweets, added sugars, sugar containing beverages, fats, and red meats than the typical American diet. This heart healthy way of eating is also lower in saturated fat and cholesterol and is rich in nutrients that are associated with lowering blood pressure—mainly potassium, magnesium, calcium, protein, and fiber.

A major study found that people who followed this eating plan reduced their blood pressure more than those who ate more "typical" American diets, which have fewer fruits and vegetables. A second study found that people who followed the DASH eating plan and cut down on sodium had the biggest reductions in blood pressure. (Salt, or sodium chloride, and other forms of sodium are found in many processed foods.) So, for a truly winning combination, follow the DASH eating plan and lower your sodium intake as much as possible. The study found that the less sodium people consumed, the more their blood pressure dropped.

The DASH eating plan is geared especially to people with high blood pressure or prehypertension, but it is a healthy plan for anyone, so share it with your family. When people who have normal blood pressure follow the DASH eating plan, especially when they also consume less sodium, they may lessen their chances of developing high blood pressure. Remember, 90percent of middle-aged Americans go on to develop high blood pressure. Use the DASH plan to help beat the odds!

"I HAVE TO LOSE WEIGHT AND REDUCE MY CHOLESTEROL. THIS IS JUST THE BEGINNING OF A LONG BATTLE, AND I KNOW IT WON'T BE EASY, BUT I KNOW I HAVE TO DO IT."

— Rosario

THE DASH EATING PLAN
The DASH eating plan shown below is based on 2,000 calories a day. The number of daily servings in a food group may vary from those listed, depending on how many daily calories you need.

HOLD THE SALT: HOW TO REDUCE SALT AND SODIUM IN YOUR DIET
You can help prevent and control high blood pressure by cutting down on salt and other forms of sodium. Try to consume no more than 2,300 mg of sodium a day—or, if you can, no more than 1,500 mg a day (2,300 mg of sodium equals 1 tsp of table salt, while 1,500 mg equals ⅔ tsp). Here are some tips on limiting your intake of salt and sodium:

Choose low-sodium, reduced-sodium, or no-salt-added versions of foods and condiments, when available.

Use fresh poultry, fish, and lean meat, rather than canned, smoked, or processed types.

Choose ready-to-eat breakfast cereals that are lower in sodium.

Limit cured foods (such as bacon and ham), foods packed in brine (such as pickles, pickled vegetables, olives, and sauerkraut), and condiments (such as mustard, horseradish, ketchup, and barbeque sauce). Limit even lower sodium versions of soy sauce and teriyaki sauce. Use these condiments sparingly, as you do table salt.

Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt.

Choose "convenience foods" that are lower in sodium. Cut back on frozen dinners, mixed dishes such as pizza, packaged mixes, canned soups or broths, and salad dressings. These foods often have a lot of sodium.

Rinse canned foods, such as tuna and canned beans, to remove some of the sodium. Salt substitutes containing potassium chloride may be useful for some individuals, but they can be harmful to people with certain medical conditions. Ask your doctor before trying salt substitutes.

When you cook, be "spicy" instead of "salty." In cooking and at the table, flavor foods with herbs, spices, wine, lemon, lime, vinegar, or salt-free seasoning blends. Start by cutting your salt use in half.

What Else Affects Blood Pressure?
A number of foods and other factors have been reported to affect blood pressure. Here are the latest research findings:

Garlic and onions. These foods have not been found to affect blood pressure, but they are tasty, nutritious substitutes for salty seasonings and can be used often.

Caffeine. This may cause blood pressure to rise, but only temporarily. Unless you are sensitive to caffeine, you do not have to limit how much you consume to prevent or control high blood pressure.

Stress. Stress, too, can make blood pressure go up for awhile and has been thought to contribute to high blood pressure. But the long-term effects of stress are not clear. Furthermore, stress management techniques do not seem to prevent high blood pressure. However, stress management may help you to control other unhealthy habits, such as smoking, overeating, or using too much alcohol.

High Blood Cholesterol and the TLC Program The TLC Program can help you to lower high blood cholesterol and protect your health. TLC stands for "Therapeutic Lifestyle Changes," a program that includes an eating plan that is low in saturated fat, trans fat, and cholesterol. The eating plan also adds plant stanols and sterols to your diet as well as more soluble fiber. The TLC Program also calls for increased physical activity and weight control. Adopt the TLC Program and you'll lower your chances of developing heart disease, future heart attacks, and other heart disease complications. (The main difference between the TLC and the DASH eating plans is that the TLC plan puts more emphasis on decreasing saturated fat and trans fat to lower blood cholesterol levels.)

EATING THE TLC WAY
If your LDL cholesterol is above your goal level, you should start on the TLC eating plan right away. The TLC eating plan will help to reduce your LDL cholesterol and lower your chances of developing heart disease. If you already have heart disease, it will lessen your chances of a heart attack and other heart-related problems. On the TLC eating plan, you should eat as follows:

Less than 7 percent of the day's total calories from saturated fat. Lowering saturated fat is the most important dietary change for reducing blood cholesterol.

Less than 200 mg of dietary cholesterol a day.

No more than 25 to 35 percent of daily calories from total fat(includes saturated fat calories).

Just enough calories to reach or maintain a healthy weight.

In addition, you should get at least 30 minutes of moderate-intensity physical activity on most, and preferably all, days of the week.

If your blood cholesterol is not lowered enough on the TLC Program, your doctor or registered dietitian may advise you to increase the amount of soluble fiber and/or add cholesterol-lowering food products. These products include margarines that contain ingredients called "plant sterols" or "plant stanol esters," which lower LDL cholesterol. If your LDL level is still not lowered enough, your doctor may prescribe a cholesterol-lowering drug along with the TLC Program. (See "To Learn More".)

"There are a lot of things I want to do in my life, so I know it's important to take care of my health. Most women put everyone else before themselves, but you can't put off taking care of your heart."

— Pattie

The Lowdown on Low Fat
Recently, a large study reported what seemed to be startling results: women who reduced their total fat intake did not significantly reduce their risks for heart disease and other serious disorders. This widely publicized Women's Health Initiative (WHI)study, which tracked more than 48,000 postmenopausal women, found that those who ate lower fat diets for an average of 8 years had about the same risk of heart attack, stroke, breast cancer, and colon cancer as did women who ate whatever they wanted.

Does this mean we can feast on french fries and fudge without a second thought? Not at all. The WHI study was designed to study the impact of reducing total fat, without distinguishing between "good" fats found in fish, nuts, and vegetable oils, and "bad" fats like saturated fat and trans fat, which are found in processed foods, meats, and some dairy products. The type of fat you eat affects your heart disease risk. Other studies have found that reducing "bad" fats lowers risks for heart disease and future heart attacks, while consuming small amounts of "good" fats may be protective. In fact, a closer look at the WHI study supports the heart benefits of reducing "bad" fats.

The bottom line is that women should continue to follow an eating plan that is low in saturated fat, trans fat, and cholesterol to reduce their risk of heart disease. (For specifics, see "Figuring Out Fat".) Most of the fat you consume each day should come from vegetable oils, fish, nuts, and other sources of polyunsaturated and monosaturated fats.

Now You're Cooking: Limiting Saturated Fat, Trans Fat, and Cholesterol
Planning and preparing nutritious meals may take a little extra effort, but the health benefits are huge. Here are some tips for cutting down on saturated fat, trans fat, and dietary cholesterol, which will help to lower your LDL cholesterol and reduce your heart disease risk. It will improve heart health for all women, and may be particularly helpful for those following the TLC eating plan.

Limit the number of egg yolks you eat. Two or fewer yolks per week—including yolks in baked goods and in cooked or processed foods. Egg whites contain no fat or cholesterol, so you can eat them often. In most recipes, you can substitute two egg whites for one whole egg.

Use soft margarines (liquid or tub types) that contain little or no trans fat. Trans fat is another type of dietary fat that raises LDL cholesterol.

Grains and Grain Products

Eat foods with lots of fiber and nutrients and make sure that at least half of your grain products are whole grain. These include whole-grain breads, pastas, and cereals, as well as brown rice. When you check package labels, look for the word "whole" in the ingredients. Make sure that whole grains appear among the first items listed.

Sauces, Soups, and Casseroles

After making sauces or soups, cool them in the refrigerator and skim the fat from the top. Do the same with canned soups.

Thicken a low-fat sauce with cornstarch or flour.

Make main dishes with whole-grain pasta, rice, or dry peas and beans. If you add meat, use small pieces for flavoring rather than as the main ingredient.

When You Can't Face Cooking

Check nutrition labels to choose frozen dinners and pizzas that are lowest in saturated fat, trans fat, and cholesterol. Make sure the dinners include vegetables, fruits, and whole grains—or add them on the side.

Choose store-bought baked goods that are lowest in saturated fat, cholesterol, trans fats, and hydrogenated (hardened) fats. Trans fats, or trans fatty acids, are formed when vegetable oil is hardened to become margarine or shortening in a process called "hydrogenation." Foods high in trans fats tend to raise blood cholesterol. Read labels. To reduce trans fats, limit products that list "hydrogenated oil" or "partially hydrogenated oil" as an ingredient. Also, remember that even no cholesterol and fat-free baked goods still may be high in calories.

Dining Out for Health
With a little planning—and a willingness to speak up—you can eat healthfully when you dine out. Here are some tips:

You're the customer. Ask for what you want. Most restaurant swill honor your requests. You have nothing to lose by asking!

Order small. To reduce portion sizes, try ordering heart healthy appetizers or children's portions as your main meal. Or, take half of your entree home with you for lunch the next day.

Ask questions. Don't hesitate to ask your server how foods are prepared and whether the restaurant will make substitutions. Ask if they will:

Serve low-fat or fat-free milk rather than whole milk or cream.

Tell you the type of cooking oil used. (Preferred types, which are lower in saturated fat, are canola, safflower, sunflower, corn, and olive oils.)

Breads: Most yeast breads are low in calories and fat—as long as you limit the butter, margarine, or olive oil. Choose whole-grain breads, which are packed with important nutrients and are full of fiber to make you feel fuller faster. Also, watch the sodium content.

Side dishes: Vegetables and grain products, including whole-grain rice or noodles. Ask for salsa or low-fat yogurt instead of sour cream or butter.

Dessert: Fresh fruit, fat-free frozen yogurt, sherbet, or fruit sorbet (usually fat-free, but ask for the calorie content). Try sharing a dessert. If you drink coffee or tea with dessert, ask for low-fat or fat-free milk instead of cream or half-and-half.

LABEL LANGUAGE
Food labels can help you choose items that are lower in sodium, saturated and total fat, trans fat, cholesterol, and calories. When you shop for groceries, look for these claims on cans, bottles, and other packaging:

Sodium claims

What they mean

Sodium free or salt free

Less than 5 mg of sodium per serving

Very low sodium

35 mg or less per serving

Low sodium

140 mg or less per serving

Low-sodium meal

140 mg or less per 3 ½ oz

Reduced or less sodium

At least 25% less than the regular version

Light in sodium

50% less than the regular version

Unsalted or no salt added

No salt added to product during processing,but this is not a sodium-free food

Fat claims

What they mean

Fat free

Less than ½ g of fat per serving

Low saturated fat

1 g or less per serving and 15% or less ofcalories from saturated fat

Low fat

3 g or less per serving

Reduced fat

At least 25% less fat than the regular version

Light in fat

Half the fat compared to the regular version

Calorie claims

What they mean

Calorie free

Less than 5 calories per serving

Low calorie

40 calories or less per serving

Reduced or less calories

At least 25% fewer calories per serving thanthe regular version

Light or lite

50% less fat or 33% fewer calories than theregular version

Know Your Foods
The following are some additional tips on shopping, cooking, and eating for heart health:

Healthy Snacking
Many snacks, including many types of cookies, crackers, and chips, are high in saturated fat, trans fat, cholesterol, sodium, and calories. But that doesn't mean you have to cut out all between-meal treats. Keep the foods listed below on hand for snack attacks. But keep in mind that while these snacks may be low in fat, many are not low in calories. So watch how much you eat, especially if you are trying to control your weight. Here are some healthier, low-fat snacks:

Low-fat crackers, such as melba toast, or rice, rye, and soda crackers. Look for unsalted or low-sodium types

Air-popped popcorn with no salt or butter; fat-free, low-sodium pretzels

Fresh or dried fruit or fruits canned in their own juice

Figuring Out Fat
Your personal "fat allowance" depends on how many calories you consume each day. If you do not have high blood cholesterol or heart disease, the saturated fat in your diet should be less than 10 percent of your daily calories, and total fat should be 20 to 35 percent of calories. Most fats should come from foods that are high in polyunsaturated fats and monosaturated fats, such as fish, nuts, and vegetable oils.

The table below shows the maximum amount of saturated fat you should eat, depending on how many calories you take in each day. If you have high blood cholesterol or heart disease, the amount of saturated fat will be different.(See "Eating the TLC Way".) Check the Nutrition Facts panel on food labels to find out the number of fat grams—both saturated and total—in each serving.

Total Calorie Intake

Limit on Saturated Fat Intake

1,200

13 g or less

1,600

18 g or less

2,000*

20 g or less

2,200

24 g or less

2,500*

25 g or less

2,800

31 g or less

*Percent Daily Values on Nutrition Facts labels are based on a 2,000-calorie diet. Values for 2,000 and 2,500 calories are rounded to the nearest 5 gram to be consistent with the Nutrition Facts label.

What's in a Serving?
The "Dietary Guidelines for Americans" offer a healthy overall eating plan. But what counts as a serving? Here's a quick rundown of the food groups and number of servings you need of each:

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